Outcome of treatment of unstable intertrochanteric fractures using proximal femoral nail augmented with trochanteric stabilization plate

K. Nafiz Rahman; M. Rezaul Karim; M. Merajul Islam; M. Shariful Alam; M. Harun-or-Rashid Paramanik; Hasnan Zobayed Kabir; M. Abdul Mottalab

doi:10.18203/issn.2455-4510.IntJResOrthop20253413

Authors

K. Nafiz Rahman Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
M. Rezaul Karim Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
M. Merajul Islam Department of Orthopaedic and Trauma Surgery, Ahsania Mission Cancer & General Hospital, Dhaka, Bangladesh
M. Shariful Alam Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
M. Harun-or-Rashid Paramanik Department of Orthopaedics, Aalok Hospital Ltd, Dhaka, Bangladesh
Hasnan Zobayed Kabir Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
M. Abdul Mottalab Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253413

Keywords:

Intertrochanteric fracture, Proximal femoral nail, Trochanteric stabilization plate, Hip fracture fixation, Functional outcome, Harris hip score

Abstract

Background: Unstable intertrochanteric fractures remain a major challenge in the elderly population, often associated with high morbidity and complications. Proximal femoral nail (PFN) fixation provides stable internal fixation, while the addition of a trochanteric stabilization plate (TSP) is expected to enhance lateral wall support, reducing implant failure and improving outcomes.

Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka and a private clinic, from July 2024 to March 2025. Thirty patients with unstable intertrochanteric fractures underwent fixation with PFN augmented by TSP. Demographic data, operative details, perioperative complications, radiological outcomes and functional results were recorded. Patients were followed up for six months and functional outcomes were assessed using the Harris hip score (HHS).

Results: The mean age was 60.3±11.5 years, with males comprising 60% of patients. AO/OTA type 31-A2 fractures were the most common (63.3%). Mean operative time was 78±12 minutes, with minimal intraoperative complications. Radiological union occurred at a mean of 15.8±2.4 weeks. Implant-related complications were infrequent, with cut-out and back-out noted in 3.3% each. Early complications included superficial surgical site infection (3.3%) and deep vein thrombosis/pulmonary embolism (3.3%). Functional outcomes improved steadily, with the mean HHS rising from 42.3±6.1 at discharge to 88.2±6.7 at 6 months, indicating satisfactory hip function recovery.

Conclusions: PFN augmented with TSP appears to be an effective fixation strategy for unstable intertrochanteric fractures, ensuring reliable fracture union, low complication rates and favorable functional outcomes.

Metrics

Metrics Loading ...

References

Hsu CE, Chiu YC, Tsai SH, Lin TC, Lee MH, Huang KC. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury. 2015;46(6):1047-53. DOI: https://doi.org/10.1016/j.injury.2015.03.007

Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femoral nail in unstable trochanteric fractures. Sicot-j. 2017;3:12. DOI: https://doi.org/10.1051/sicotj/2016052

Tang Y, Wang D, Wang L, Xiong W, Fang Q, Lin W, et al. The PFNA in treatment of intertrochanteric fractures with or without lateral wall fracture in elderly patients: a retrospective cohort study. Euro J Med Res. 2023;28(1):380. DOI: https://doi.org/10.1186/s40001-023-01332-y

Singh AK, Narsaria N, G RA SV. Treatment of unstable trochanteric femur fractures: proximal femur nail versus proximal femur locking compression plate. Am J Orthop (Belle Mead NJ). 2017;46(2):E116-23.

Kassem E, Younan R, Abaskhron M, Abo-Elsoud M. Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial. Joint Dis Related Surg. 2022;33(3):531. DOI: https://doi.org/10.52312/jdrs.2022.800

Fu CW, Chen JY, Liu YC, Liao KW, Lu YC. Dynamic hip screw with trochanter‐stabilizing plate compared with proximal femoral nail antirotation as a treatment for unstable AO/OTA 31‐A2 and 31‐A3 intertrochanteric fractures. BioMed Res Int. 2020;2020(1):1896935. DOI: https://doi.org/10.1155/2020/1896935

Tucker A, Donnelly KJ, Rowan C, McDonald S, Foster AP. Is the best plate a nail? A review of 3230 unstable intertrochanteric fractures of the proximal femur. J Orthop Trauma. 2018;32(2):53-60. DOI: https://doi.org/10.1097/BOT.0000000000001038

Hassan MK, Al Gyoushi AM, Abdelkader MG. Augmented Proximal Femoral Nail in Unstable Intertrochanteric Fracture Femur. Al-Azhar Int Med J. 2024;5(7):34. DOI: https://doi.org/10.58675/2682-339X.2552

Purushotham VJ, Khan MA, Kumar N. Original Research Article Efficacy of proximal femoral nail augmentation in unstable intertrochanteric fracture. Int J Res Orthop. 2020;6(5):1043. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203729

Rajput AK, Gupta PK, Gill SP, Singh SK, Raj M, Singh J, et al. Prospective comparative study between proximal femoral nail vs. screw augmented proximal femoral nail in unstable intertrochanteric fractures of femur. Cureus. 2022;14(12). DOI: https://doi.org/10.7759/cureus.32791

Zhang S, Zhang K, Jia Y, Yu B, Feng W. InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013;36(3):182-e292. DOI: https://doi.org/10.3928/01477447-20130222-16

Akan K, Cift H, Ozkan KO, Eceviz E, Tasyikan L, Eren A. Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail. J Int Med Res. 2011;39(3):857-65. DOI: https://doi.org/10.1177/147323001103900319

Zhu Z, Yang Y, Li L, Zhu SJ, Zhang L. A probabilistic approach for assessing the mechanical performance of intertrochanteric fracture stabilized with proximal femoral nail antirotation. Plos one. 2024;19(4):e0299996. DOI: https://doi.org/10.1371/journal.pone.0299996

Jiamton C, Boernert K, Babst R, Beeres FJ, Link BC. The nail–shaft-axis of the of proximal femoral nail antirotation (PFNA) is an important prognostic factor in the operative treatment of intertrochanteric fractures. Arch Orthop Trauma Surg. 2018;138(3):339-49. DOI: https://doi.org/10.1007/s00402-017-2857-x

Bonnaire F, Lein T, Fülling T, Bula P. Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus PFNA. Euro J Trauma Emerg Surg. 2020;46(5):955-62. DOI: https://doi.org/10.1007/s00068-019-01200-7

Abd Alkhalik WS, Hassaan AM, Mostafa AG, Saad AM. Comparative Study between Short Proximal Femoral Nail Versus Dynamic Hip Screw with Trochanteric Stabilizing Plate for Unstable Intertrochanteric Fractures. Egyptian Orthop J. 2025;60(2):159-64. DOI: https://doi.org/10.21608/EOJ.2025.431797

Zheng L, Chen X, Zheng Y, He X, Wu J, Lin Z. Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures-a comparative finite element study. BMC Musculoskeletal Disorders. 2021;22(1):1010. DOI: https://doi.org/10.1186/s12891-021-04878-2

Ganjale SB, Gadegone WM, Kothadia P. Trochanteric buttress plate combined with proximal femoral nail for unstable intertrochanteric fractures.[Innovative technique]. Open J Orthop. 2018;8(06):235. DOI: https://doi.org/10.4236/ojo.2018.86027

Jain S, Dawar H, Khare H, Kumar M, Ajmera A. Does augmentation of intramedullary nails by a buttress plate effectively restore lateral wall integrity in intertrochanteric fractures. Int Orthop. 2022;46(10):2365-71. DOI: https://doi.org/10.1007/s00264-022-05488-w

Ravindranath VS, Yalamanchili RK, Palla SR, Baddula AR, Mudavath S, Vuthpala VM. Trochanteric buttress plate augmentation–is the buttressed lateral wall integrity an effective way for good outcome of pertrochanteric fractures treated by proximal femoral nail?. J Telangana Orthop Surg Assoc. 2023;1(1):20-4.

Walmsley D, Nicayenzi B, Kuzyk PR, Machin A, Bougherara H, Schemitsch EH, et al. Biomechanical analysis of the cephalomedullary nail versus the trochanteric stabilizing plate for unstable intertrochanteric femur fractures. Proceedings of the Institution of Mechanical Engineers, Part H: J Eng Med. 2016;230(12):1133-40. DOI: https://doi.org/10.1177/0954411916676508

Nie S, Li M, Ji H, Li Z, Li W, Zhang H, Licheng Z, Tang P. Biomechanical comparison of medial sustainable nail and proximal femoral nail antirotation in the treatment of an unstable intertrochanteric fracture. Bone Joint Res. 2020;9(12):840-7. DOI: https://doi.org/10.1302/2046-3758.912.BJR-2020-0284.R1

Zhao Y, Wang H, Liu Y, Shan L, Zhou J. Augmentation of intramedullary nail in unstable intertrochanteric fractures with plate or cable. Frontiers Surg. 2024;11:1293049. DOI: https://doi.org/10.3389/fsurg.2024.1293049

Kulkarni SG, Babhulkar SS, Kulkarni SM, Kulkarni GS, Kulkarni MS, Patil R. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study. Injury. 2017;48:S18-22. DOI: https://doi.org/10.1016/S0020-1383(17)30489-8

Eberle S, Gabel J, Hungerer S, Hoffmann S, Pätzold R, Augat P, et al. Auxiliary locking plate improves fracture stability and healing in intertrochanteric fractures fixated by intramedullary nail. Clin Biomech. 2012;27(10):1006-10. DOI: https://doi.org/10.1016/j.clinbiomech.2012.07.008